IVF/ICSI联合治疗在体外助孕周期中的应用价值

目的:对原发不孕≥5年,男方精液正常或原发不孕≥4年,伴男方精液异常但达不到卵胞浆内单精子显微注射(ICSI)指征的患者,探讨是否存在IVF联合ICSI治疗的必要性与可行性。方法:2006年8月～2009年3月接受体外助孕的夫妇中,选取符合指征者,采用常规超排卵方案,同一周期取得的卵子随机分半,分别进行常规体外受精(IVF)与ICSI治疗。卵裂球≥4个且碎片≤30%的胚胎为可用胚胎。结果:共78个周期采用IVF联合ICSI治疗,其中常规IVF受精失败或低下(LFR)17个周期(21.8%);同期常规IVF治疗204周期,其中LFR8个周期(3.9%),两者LFR周期发生率有显著差异(P<0.005)。研究组共获959枚卵子,其中行常规IVF 470枚,受精率56.8%,行ICSI 408枚,受精率72.3%。两者受精率有显著差异。78个周期临床妊娠率为37.2%。结论:存在对原发不孕≥5年,男方精液正常或原发不孕≥4年,伴男方精液异常但达不到ICSI标准者行IVF联合ICSI治疗的必要性,可明显减少不受精情况的出现。对常规IVF与ICSI均受精的周期,可优先选择移植常规IVF胚胎,以减少子代遗传和先天缺陷的风险。

Application value of IVF/ICSI in assisted reproductive treatment in vitro

Objective:To explore the necessity and feasibility of in vitro fertilization(IVF) combined with intracytoplasmic sperm injection(ICSI) for the patients with primary infertility≥5 years,normal semen or primary infertility≥4 years,abnormal semen,falling short of the indications of ICSI.Methods:The couples who were in accordance with the indications and underwent assisted reproductive treatment in vitro from August 2006 to March 2009 were selected,conventional hyperovulation scheme was adopted,the eggs obtained during the same cycle were divided into two groups randomly,then they were treated with conventional IVF and ISCI,respectively.The embryos with the number of blastomeres≥4 and the proportion of fragment≤30% were the available ones.Results:A total of 78 cycles were treated with IVF combined with ICSI,17 cycles(21.8%) were found with conventional IVF failure or low fertilization rate(LFR);204 cycles were treated with conventional IVF,and 8 cycles(3.9%) were found with LFR,there was significant difference in the incidence of cycles with LFR(P<0.005).In study group,a total of 959 eggs were obtained,470 eggs underwent conventional IVF,the fertilization rate was 56.8%;408 eggs underwent ICSI,the fertilization rate was 72.3%.There was significant difference in the fertilization rate between the two groups.The clinical pregnancy rate of 78 cycles was 37.2%.Conclusion:IVF combined with ISCI is necessary for the patients with primary infertility≥5 years,normal semen or primary infertility≥4 years,abnormal semen,falling short of the indications of ICSI,which can reduce the occurrence of nonfertilization.For the cycles with fertilization after both conventional IVF and ICSI,routine IVF embryo transplantation is the first choice to reduce the risk of genetic and congenital defects of the offsprings.